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  • Nathan Riley, MD

This is Not an Article about Coronavirus: Birth, Death, and our Grapple with Safety

Updated: Dec 11, 2020



Through this essay, I hope to engage you in a discussion around how our treatment of the birthing and the dying processes reflect our unreasonable fear of death and how our short-term efforts to prevent death of humans from all causes may lead to severe long-term consequences for people and the planet. I also argue that our efforts to mitigate the fear surrounding SARS-CoV-2 perfectly exemplify our willingness to compromise richness and quality in our lives in the name of safety.


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In June 2020, my grandfather turned one-hundred years old. Against cautions and warnings of safety, I flew to Silver Spring, Maryland, to celebrate him. My family in masks, we distanced socially outside the door of his nursing facility awaiting a friendly staff member to roll him out in a wheelchair. The county's newest centenarian was dressed from head to toe in plastic wrap, complete with mask, gloves, and face shield. We sang to him, gave him gifts, and asked him for sage wisdom.


"It's lonely to be a hundred," he said.


My grandfather had been praying to God for five years to take him and my grandmother up to heaven. And now, in the age of coronavirus, he's stuck peering at three generations of family members through a face shield, unable even to wipe the tears of despair from his eyes due to the limitations of his plastic wrap and gloves.


I reached out and grabbed my grandfather's hand despite the safety precautions offered by the helpful staff member. It was the last loving touch that he experienced, as he died soon after at the age of 100 years, 2 months. He didn't die of COVID-19; Grandpap died of old age. And he died in a nursing facility within earshot of my demented grandmother, deprived of the loving touch of his family.


Before I continue, I would be remiss if I didn't share with you that my wife and I, along with our daughter, just recovered from SARS-CoV-2. It was a crummy few days, but we are alive and well, apart from the lingering lack of olfactory gusto, which is frustrating in the very least. Since the beginning of this coronavirus business, we've been quarantined with a baby, and we have decided as a family with whom we felt comfortable breaking bread and where and when we have felt safe to travel. We have no regrets as to how we spent our time, and now we are paying the consequences, as a family, for those decisions.


What I do regret is that the mass hysteria around the dangers of coronavirus kept my only living grandparents from seeing their great-grandchild. You see, a few weeks after my grandfather passed away, his 94-year-old wife died. My dad missed out on meeting Penélope-Luz because he died younger than we would have wished. My grandparents, on the other hand, were denied this trans-generational meeting as a consequence of our species' dictum of "safety first".


My primary medical specialty is obstetrics and gynecology, but my subspecialty is hospice and palliative medicine. This - along with my own personal experiences with loss - puts me in a unique position to judge how the predominance of safety and our fear of death impact our life experience.


I should emphasize that the purpose of this article is not to make light of the loss of human lives. The deaths of parents and friends leads to unparalleled anguish. I lost my dad to multiple myeloma when I was only twenty-seven years old, and it was one of the hardest realities I have ever had to bear. If you have lost somebody to COVID-19 or otherwise, I empathize and sympathize with you sincerely. I also sympathize with our health care workforce, which has been working harder than you know to counter the realities of human mortality, an especially challenging task in the age of COVID-19.


Apart from drawing us closer to our families, coronavirus came with few silver linings. Our frustration with the Trump administration is particularly well-grounded. The person elected to sit in the oval office for four years is more than just a paper pusher. The President should reflect our nation's deepest values, and President Trump reflects the exact opposite of what many of us hold dear as a civilization. Moreover, his dismissal of the virus was rightfully seen as a dismissal of the thing we humans fear most: death.


Our fear of death is surprising, given it's the only thing - apart from birth - that you will experience with 100% certainty. But not all is lost, my friend! We do get a say as to how we die and how we live, and that's a pretty great compromise, in my opinion.


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Two weeks prior to his death, my grandfather was hospitalized because he became confused, and where do we take old people who are confused? We take them to the hospital.


The logic follows as such: this old person has an infection or dehydration or any of the multitude of other causes of confusion in old people, so we ship them off to hospitals where they can be properly evaluated and treated. My grandfather had been pleading for years never to be taken back to a hospital, but he was transported by his facility staff nonetheless just to be safe, and his confusion became worse before it got better. Fortunately, his mentation clarified, and we succeeded in getting him back to the nursing facility just in time for him to die a few days later.


Our discomfort with dying prompts us to send people to hospitals in the name of safety. As such, it makes perfect sense to go to the hospital when we are sick. Hospitals aim to keep us safe, which is reassuring given our fear of dying. But where can we go when we take that turn towards death? Even hospitals can't protect us from our own mortality, and in many ways, hospitals make the dying process miserable. Think critically about this: does the dying process present a situation in which an over-reliance on safety is detrimental?


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This brings us to the novel coronavirus. For nearly 10 months, we have been asked to radically change our lives in the name of safety, but I implore you to consider the short- and long-term consequences of this motif.


The human microbiome consists of 40 trillion individual bacterium. The number of viruses in our microbiome has never been estimated, but given that, in nature, viruses outnumber bacteria 10:1, we are looking at a metric fuck-ton of viruses living on and inside our bodies. Our microbiome is delicately balanced to ensure proper functioning of our physiology while we are alive, and as our bodies become old and tired, our microbiome does the job of composting our bodies into reusable soil. In other words: we live in harmony with bacteria, fungi, protozoa, and viruses.


Yet humans have long held the belief that we are separate from nature. We have invested in this story so deeply that we seem to think that eventually we'll think our way out of mortality altogether. Our actions as physicians serve this narrative well. Indeed, a human life lost is treated as the ultimate failure of modern medicine. As a result, of course a centenarian would want to be put on a ventilator. If we don't do it, he'll die.


Well what if that centenarian is mostly blind, nearly deaf, and has been praying for years that God take him to heaven? It's as if we are only able to accept death after we've "tried everything" and gone financially broke in the process.

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It's bad enough that my grandfather had to die without the warm, compassionate touch of his loved ones, but our society's actions in the name of safety go far deeper. Consider the behaviors of the medical systems' treatment of birth.


I receive correspondence from women on a regular basis who have felt violated by a medical staff member in the hospital where they gave birth.


"Was that procedure necessary?"

"Why didn't I get to see my baby immediately after the birth?"

"They never told me about the risks or benefits of _________ ."

"They held me down while the doctor forced her hand inside of me. And she didn't stop when I told her she was hurting me."


I encourage these women to write letters to the hospital administration and to file formal complaints, and they are told ubiquitously that "we needed to do that to keep you and your baby safe". I've reviewed these cases, and not only is the baby rarely in danger, but there is nearly always ample time for the clinician not only to discuss the risks and benefits of such procedures with their patients but also to allow their patients ample time to refuse treatment when a physician's recommendations didn't feel right.


For far too long, we've used the argument of "safety" to subject women to non-consensual touching or penetration. We simply can't stomach the fact that a baby is occasionally going to die in childbirth no matter what fancy tricks we use to deceive ourselves into believing otherwise. And this quest to reduce bad outcomes to zero - even in the rare instance in which a fetus is perhaps physically unfit for the rigors of labor and birth - has led to the traumatizing loss of dignity for birthing women. It's no longer about consent, the sacred experience of giving birth, or our patients' capacity for medical decision-making. As a medical system, we have determined that we are willing to cause harm to women based on the belief that doing so will avoid the rare circumstance in which a baby does not survive childbirth. In other words, we have judged that we are more comfortable with traumatizing women and stripping them of bodily autonomy than risking harm to the unborn baby.


The influence on a woman's emotional and psychological well-being aside, this myopic focus on safety in an otherwise inherently dangerous business of being born has inadvertently led to very real threats to women's safety in future pregnancies.


Take cesarean deliveries, for example. Forty percent of babies in the United States are born by an incision in the abdomen in the name of safety, yet every obstetrician on planet earth knows that the majority of these surgeries are unnecessary. We also know that a history of cesarean delivery carries vastly more dangerous consequences in future pregnancies. This is a clear example of short-term gain at the expense of long-term detriment down the road. With this in mind, is a woman really acting unreasonably when she declines these surgeries or when she is adamant about a trial of labor after cesarean delivery?


To be very clear, I am not apologizing on behalf of physicians or midwives who neglect signs of fetal distress that may warrant further investigation or even surgical interventions. I'm merely suggesting that the prioritization of bad outcomes inappropriately falls to the clinician while heeding little regard for the impacts of stripping away a patient's rights. The lifelong PTSD of being subjected to an unwanted surgery or vaginal exam is born by the patient of whom we have generally lost sight. And yes, there are occasions in which we must act on the behalf of patients who lack capacity for complex medical decision-making, but these instances are far and few between.


In this way, dignity has been lost in many hospital-based birthing units in the same way that a dignified death is rarely seen in modern hospitals.


Had my grandfather been less vocal about staying out of the hospital - or had he not had a loud-mouthed grandson who is a palliative care physician - he likely would have lived out his final moments amidst beeping machines, sleep disruptions, and 4:00 am needle sticks. Like many Americans, he would have died in a hospital bed, perhaps on a ventilator, perhaps thinking about the one-hundred years that had preceded him and how this is a really shitty way for things to end.


Death - whether that of a newborn or a wise elder - has become our ultimate failure. This is why women who experience miscarriages or stillbirth are left alone with their feelings. It's far too icky to talk about. Likewise, we don't talk about death until the moment comes where a pulmonologist is asking your family for permission to intubate and ventilate you: "If we don't do this, he will die!" Safety first, of course. Proceed.


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This brings me back to our current struggle with SARS-CoV-2. The media's representation of this virus would have you believe that this thing is the newest iteration of the Black Death, which wiped out nearly a third of Europe's population in the mid-14th century (and it was characterized by bright red bloody vomiting and blood-filled pustules across the body...quite different). It's also impossible to deny just how politicized this virus became in the midst of one of the most challenging U.S. elections of the past century. Willingness to cooperate with mask mandates became a surrogate for your "liberalness". Many of my most open-minded friends have even adopted the language of coronavirus fearmongers just so that "people know which side I fall on". I can't disagree with them. The political nature of this virus has taken on an identity of its own. And while I'm not a fan of conspiracy theories, is it too hard to imagine lobbyists for pharmaceutical companies and vaccine manufacturers taking the opportunity to leverage profits from a pandemic?


We could take the headlines at face value:

A New Virus Has Emerged That Could Threaten Humanity!!!


Then again, it's clearly not as bad as the Black Death even in the United States where we have treated social distancing as a call to reimagine garden parties. Yet due to the perversion of science and the flood of completely useless journalism that we've witnessed since the outbreak of this thing - on both sides of the aisle, mind you - we may unfortunately never really know how dangerous this virus is compared to the likely 400 trillion viruses in our microbiome.


So what are we to do?


In the name of safety, the plan thus far has been to socially isolate, wear masks, and shut down local businesses, and this plan works if you strictly look at the number of positive coronavirus screens and ignore risk factors for severe infection or the low number of deaths or long-term morbidity caused by this virus in otherwise healthy people. But what we aren't considering is the cost of the perception of safety.


We fail to recognize the impacts of isolation for single people, children, aging grandfathers, people who suffer from severe depression and anxiety, and people living with heart disease who are now afraid of going to hospitals even for chest pain.


We fail to recognize the long-term costs of extreme unemployment through the closure of small businesses and the resulting loss of healthcare coverage for many of our neighbors in the only developed nation that cares too little about its citizens to provide basic healthcare resources.


We fail to recognize the tremendous waste of non-renewable resources to produce personal protective equipment in an effort to safeguard every last human from this virus. As I mentioned before, our mythology tells us that the ultimate failure is the death of a human. But how many forests are being raised in order to make more room for the discarded gowns, masks, and gloves we don every time we provide needed touch to a sick or outright lonely person? Perhaps this dismal outlook is in the very least balanced by the positive impacts on our carbon footprint resulting from decreased travel and tourism.


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Have we forgotten that we are all going to die some day? And as we age, the likelihood that we will die in any given year increases, whether from a virus or otherwise. This is human life. We can't change mortality, nor should we try to do so at the expense of everything that makes life rich for us or the other species that co-inhabit this planet. The spiritual transformation tendered by the dying process is a joyous, momentous opportunity not to be taken for granted.


And this is not to say that efforts to prevent the spread of disease are futile. Those with a compromised immune system and those who are living under the centuries-old societal structures rooted in racism and inequality lack the luxury to consider the consequences of a nasty, potentially lethal viral infection. Our efforts to protect the vulnerable in our world should be a priority in every walk of life, so this argument of "safety first" in the name of helping the poor and innocent is of the "straw man" variety, as many people have only recently become interested in fighting for equality because their own creature comforts are newly being threatened. Of course we should do our best to prevent the spread of disease. We should wash our hands after we use the toilet; wear gloves when touching mucosa, bodily fluids, or open wounds; and we should invest in toppling the power structures that leave black women afraid of dying in childbirth at higher rates than white women or afraid of being gunned down while on a jog in a predominantly white neighborhood.


Inequality in the provision of safety is a separate, very important issue altogether. Our shortcomings to care for people of every race and creed with equal respect and dignity aside, I maintain that every casualty of this virus is not due to an inherent failure to impart safety and that it, in fact, carries a heavy, heavy price.


To illustrate my point here, ask yourself: If I could live for another twenty years loving, laughing and touching in the ways that I could before this pandemic, would I choose this over fifty years of living in a place of fear, where I'm forced to question the safety even of hugging my own mother? Or kissing a stranger? Or hosting a dinner party? Or getting the whole gang together for a pool party at Kevin's?


Perhaps it's time to begin worrying less about if we'll die, and focus instead on how we can live our best lives? The best that we can do is eat whole food, exercise just enough, rest just enough, and drink clean water, and even our best isn't a guarantee against infection, cancer, or any other malady that may cause us to die earlier than we hope. (Note: In case you're curious, here's my comprehensive list of what you can do to keep yourself healthy)


I repeat: at what cost are we willing to live in fear under the guise of safety?


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I know what you're thinking: "I'm willing to live like this in the short-term because it will allow us to live more safely in the future when this all passes."


As presented in the example of cesarean birth, we are genuinely poor at managing short- versus long-term risk. This is why our planet is in peril and why birthing women are losing faith in the short-sighted medical system.


Furthermore, our species is drifting further away from critical thinking for ourselves. We love being told what to do. If we aren't looking to the sky for guidance from an imaginary father figure, we are returning to the same lousy news channels daily to refresh our understanding of how our elected officials would prefer that we live our lives.


This fear of critical thinking has led to our tendency to distract ourselves with the mirage of free will by praying to gods or electing officials who can make decisions for us. By ceding this power to others, we are given the easier decision of agreeing or disagreeing with whatever dicta are passed down from above. If we agree then those who disagree must be our enemy. It is precisely in this way that religions and political systems since the dawn of man have managed to leverage power. "We the people" have been trained to fear the "other", the "outsider". And coronavirus is an outsider.


Failing to take into account our important role in the balance of the ecosystem of ecosystems that we call Earth, we see a virus as a foreign enemy that must be destroyed. This pandemic has given us the opportunity to flex our collective minds and muscle to demonstrate just how superior human beings are in comparison to our microscopic companions, just as we have done in any war between nations or neighboring tribes, the haves and have-nots. For decades, humans on this planet have diverted their eyes from worsening rates of homicide, homophobia, poverty, and ecological destruction. We have become our own worst enemy, but when this coronavirus appeared, it allowed us to turn our attention to a common enemy, and we have taken out all the stops to squash it.


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We will move forward as a species and as a planet, and it's now up us to decide how we want that future to look. My fear is that our mythology around safety has been driven deeper than ever. As if it weren't bad enough that our fear of mortality has challenged our ability as a people to accommodate dignified birth and death, our fear of dying from this virus is now going to be used to justify ongoing mandatory vaccinations, ongoing closures of small businesses, ongoing fear of being intimate with our friends and family, and our already well-entrenched xenophobia.


Our society has already demonstrated its inability to manage risk through its mistreatment of women in birth. And now we are demonstrating that we are willing to sacrifice life itself as we run in fear of this virus. So when people tell me that our investment in "safety" today will be compensated with longevity later, I'm naturally a little suspicious.


The reality is that as the current virus du jour begins to fade, another big, bad virus will be brewing on the horizon. As we find ways to protect ourselves from one strain, other strains will pop up. This is what viruses do. This is what viruses have always done, whether or not we have rapid tests, lockdowns, or vaccines.


It's critical to remember that viruses are just as important a part of the global biological fabric as humans, and I'm seeing a tremendous amount of suffering as we grapple with this truth. Occasionally a virus like smallpox does emerge, and such a virus might truly threaten civilization. If you don't believe me, read Richard Preston's book "The Demon in the Freezer". It's about the eradication of smallpox, and it gave me nightmares when I first read the book back in grade school. Coronavirus is a snotty-nosed kindergartner compared to smallpox, and we should all hope that our national response to such a virus is far more thoughtful and unified than our response to SARS-CoV-2.


But we don't need a virus to remind us of the precious, miraculous nature of life on this planet. We value white human lives above all, which is the only reason for which this has come to the forefront of our news feed. For decades, Americans have known about the plight of hungry children with swollen bellies in Malawi. We have also known about the rampant elimination of species of birds, insects, mammals, plants, and coral reef, which has accelerated over the past several decades. But the prospect that our longevity as white humans might be threatened is such an affront to our mythology of self-importance that we have become willing to sacrifice the very richness of our own lives in defense against the enemy.


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If any lesson is to be learned from 2020, it should be that the world is capable of uniting around a common threat - perceived or otherwise. In what seemed like a matter of days, the world's governments united together to reprioritize resources in an effort to halt the attack of a novel enemy: SARS-CoV-2. When the dust settles, we might consider what it would look like if we pooled our resources and focused our energy on more grave dangers to our life on this planet, namely bigotry, financial interests in our political systems, the wealth inequality gap, and the pending ecological catastrophe on the horizon.


I don't have the answers as to how to right this ship, but if we were genuinely concerned about the safety of human beings, it seems that a good place to start would be to turn our attention to the issues that truly threaten humanity at large. We would take our personal health more seriously. We would see the best in our neighbors instead of fearing them. We would lead with loving kindness instead of hate. We wouldn't rely as much on authority figures to tell us how to live a life filled with vitality and joy. Instead of looking to elected officials and billionaires to "protect" us from beasties, perhaps we would venture to take our power back in order to build a more beautiful, more egalitarian society. And lastly, we might stop destroying life on Earth as if we were its sole inhabitants.


These are not easy tasks as, in order for us to change our trajectory as a species, our missiles will have to be turned on ourselves. We will have to take a long look in the mirror. We will have to change, and we've proven throughout history that this is far scarier and more challenging than standing up to a microscopic foe.



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